Systematic review of evidence for the benefits of telemedicine
ABSTRACT A systematic review of telemedicine assessments based on searches of electronic databases between 1966 and December 2000 identified 66 scientifically credible studies that included comparison with a non-telemedicine alternative and that reported administrative changes, patient outcomes, or results of economic assessment. Thirty-seven of the studies (56%) suggested that telemedicine had advantages over the alternative approach, 24 (36%) also drew attention to some negative aspects or were unclear whether telemedicine had advantages and five (8%) found that the alternative approach had advantages over telemedicine. The most convincing evidence on the efficacy and effectiveness of telemedicine was given by some of the studies on teleradiology (especially neurosurgical applications), telemental health, transmission of echocardiographic images, teledermatology, home telecare and on some medical consultations. However, even in these applications, most of the available literature referred only to pilot projects and to short-term outcomes. Few papers considered the long-term or routine use of telemedicine. For several applications, including teleradiology, savings and sometimes clinical benefit were obtained through avoidance of travel and associated delays. Studies of home care and monitoring applications showed convincing evidence of benefit, while those on teledermatology indicated that there were cost disadvantages to health-care providers, although not to patients. Forty-four of the studies (67%) appeared to have potential to influence future decisions on the telemedicine application under consideration. However, a number of these had methodological limitations. Although useful clinical and economic outcomes data have been obtained for some telemedicine applications, good-quality studies are still scarce and the generalizability of most assessment findings is rather limited.
- SourceAvailable from: Netta Beer
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- "During the past two decades, many broad reviews of telemedicine have been published, describing the state of knowledge and assessing – to some extent – the quality of the evidence at hand. Some reviews are wide ranging both in scope and geography , , some are broad in scope but restricted to some countries , some deal with specific perspectives of application (like diagnostic and management decisions) , , and rare ones look at costs . Two recent systematic reviews added to the literature in this area: one assessed the effect of telemedicine on professional practice and on patient health care outcome  and the other was a systematic review of reviews about the effectiveness of telemedicine . "
ABSTRACT: To systematically review the literature on image-based telemedicine for medical expert consultation in acute care of injuries, considering system, user, and clinical aspects.PLoS ONE 06/2014; 9(6):e98539. DOI:10.1371/journal.pone.0098539 · 3.23 Impact Factor
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- "In the Design column, the level of scientific proof is indicated in parentheses . performance of implantable Doppler would need to be assessed by exclusively comparing buried flaps). "
ABSTRACT: OBJECTIVE: The purpose of this paper is to evaluate the efficacy and cost-effectiveness of the implantable Doppler system based on the analysis of the available scientific literature and clinical and cost data available in our hospital. The results of this system are compared to those of conventional free flap monitoring methods. MATERIALS AND METHODS: The literature published between 1991 and 2011 was systematically reviewed. All available cost data were collected and several simulations were performed. A retrospective assessment of the efficacy of conventional methods in our hospital was also conducted. RESULTS AND CONCLUSION: The implantable Doppler system is more effective than the conventional methods used to monitor free flap perfusion. The mean flap salvage rate with the implantable Doppler was 21 percentage points higher (81.4 vs. 60.4). The excess cost compared to conventional methods was about CAD 120 per patient (about EUR 94). However, this excess cost can be compensated or even reversed, depending on the initial flap salvage rate in the health facility and the type of free flap (buried vs. non-buried).European Annals of Otorhinolaryngology, Head and Neck Diseases 04/2013; 130(2):79-85. DOI:10.1016/j.anorl.2012.07.003
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- "Systematic reviews have identified evidence for the advantages of telemedicine to society [48,15]. However there are still significant gaps in the evidence base between where telemedicine is used and where its use is supported by high-quality evidence . "
ABSTRACT: Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur. The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify suitable financial and professional incentives for potential telemedicine users and understand their importance for widespread adoption.BMC Medical Informatics and Decision Making 01/2012; 12:1. DOI:10.1186/1472-6947-12-1 · 1.50 Impact Factor